Cases linked to an outbreak of tuberculosis (TB) connected to a pub in a Welsh village continue to occur more than a decade later, it has been found. A recent report into the TB outbreak which has seen dozens of cases since 2010 in Llwynhendy has described the initial response as "inadequate".
The report, chaired by Professor Mike Morgan, ex-national clinical director for respiratory disease for NHS England, identified four phases of the outbreak between 2010 and 2022. According to the report, the outbreak first occured in Llwynhendy when a 71-year-old connected to a pub in the village contracted the disease.
The report, which was jointly commissioned by Hywel Dda health board and Public Health Wales (PHW), stated that she was identified in 2010 and had been highly infectious for a prolonged period of time due to a delay in her diagnosis.
Read more: Police issue arrest update after man's body found in Cardiff
As a result of the "inadequate" first response to the outbreak, infected people were unrecognised and developed active disease, passing the infection on to others. In 2018, a woman died during the outbreak, but it was not until 2019 that the outbreak was "formally discussed at board level" between Hywel Dda and PHW, following press interest, a community screening programme and a written complaint to PHW.
The report also found there was no designated TB lead consultant or dedicated TB nurse to run a disease specific service at the start of the outbreak, while the outbreak control team was closed down prematurely and had to be re-opened on three further occasions as more cases presented including one fatal case of the illness.
In 2019, dozens of people thought to have been exposed to the infection in the Llwynhendy area were told to attend screening sessions for TB. Speaking to WalesOnline at the time, a woman, who did not want to be named, said she had a family member with TB in the Llanelli area, and claimed the screening programme was long overdue.
The report found that the first approach to the outbreak was "too casual" and public health professionals did not think the spread of TB was "likely to become as serious as it did." It also found failings linked to contact tracing, stating: "infected people were unrecognised and developed active disease, passing the infection on to others."
Professor Morgan also found that staff shortages within local services contributed to the inadequate response. The reports stated that it was not until 2014 when Dr Llywellyn Jones was appointed lead clinician - overseeing the response to the outbreaks - that "there had been a significant improvement in the care of patients with TB and their contacts".
However, Professor Morgan's report warns the initial outbreak "continues to cause concern now" and may become the "source of future outbreaks". It is estimated that 31 cases of active TB and 300 cases of latent TB were linked to the first outbreak in Llwynhendy in 2010.
Since then the response has traced 663 individual contacts and held a community screening programme which tested 1,950 people - finding a "surprisingly" high level of TB infection, particularly those who have had "historical" contact with the pub. The report added: "Although we cannot be certain that the high level of TB infection in the community is all related to the outbreak, it does suggest that there is a high risk of community outbreak in the future."
Cases of TB with known connections to the local public house in Llwynhendy continued to be identified up until July 2020 for the active cases and April 2022 for the last latent case, the report said.
Professor Fu-Meng Khaw, National Director for Health Protection and Screening Services, and Executive Medical Director for Public Health Wales, said: “Public Health Wales extends our sincere sympathies to all those who have been affected by the outbreak of Tuberculosis (TB) within the community of Llwynhendy, Carmarthenshire since 2010.
“As an NHS organisation, we take our responsibility to protect the health of people in Wales very seriously, which is why this external independent review was commissioned, to ensure that we learn from this outbreak event and take steps to ensure that we make changes and improvements. We accept the recommendations of this review in full.
“Whilst the review found that public health management improved considerably in the later stages of the outbreak, it is clear that the initial response was not satisfactory and that our contact tracing and management of the Outbreak Control Team could have been better. We are sincerely sorry to anyone who may have been impacted.
“Managing such a complex TB outbreak is challenging due to the elaborate social networks and often extended timescales involved but we want to reassure the public that we have already taken on board the lessons highlighted in the review, and have made substantial improvements in the way we handle such outbreaks.
“Public Health Wales and Hywel Dda University Health Board wish to reassure the public that lessons have been learnt and that we have published a full action plan to address the review’s recommendations. This includes a commitment to action to raise awareness amongst the public and healthcare professionals, to reduce the risks of any future outbreaks; to put in place TB specific processes to ensure that links between cases are uncovered quickly; and to agree with the Welsh Government a TB strategy and delivery plan to reduce the incidence of tuberculosis in Wales.
“We are also reminding people that this outbreak is not over. We urge the 470 people who have been written to and invited for screening, but who have not yet responded to their invitation, to come forward.”
Professor Philip Kloer, Medical Director and Deputy Chief Executive for Hywel Dda University Health Board, said: “We recognise the impact this outbreak has had on the Llwynhendy community and on behalf of Hywel Dda University Health Board, I offer my sympathies to all who have been affected.
“Hywel Dda University Health Board fully accepts the recommendations of the review and is committed to delivering on our action plan to develop our local TB service for both this ongoing outbreak and any future outbreaks.
“I would like to thank Professor Mike Morgan and his panel for their work on this report that provides important and independent recommendations to ensure improvements in the management of any future TB outbreaks.
“Investment and improvements have already been made to the TB service within the health board and this will be further reviewed to meet the needs of the local population.
“This outbreak has not ended, and we reiterate the call for those who have been invited for screening but have not yet come forward to do so as soon as possible and encourage ongoing awareness within the community of TB and its symptoms.”
Read next:
